Spacer molds with releasable securement

ABSTRACT

A mold for forming a temporary prosthesis has at least two mold members at least partially separable from each other. The at least two mold members cooperatively define a generally enclosed interior cavity for forming the temporary prosthesis. The mold has a securement structure mounted on the at least two mold members for securing the at least two mold members to each other during the forming of the temporary prosthesis. The securement structure is removable from the at least two mold members by hand and without the use of a tool.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. application Ser. No.13/788,920, filed Mar. 7, 2013, which is a continuation of U.S.Application Ser. No. 12/328,159, filed Dec. 4, 2008, now patented asU.S. Pat. No. 8,414,286, which claims priority to U.S. ProvisionalApplication Ser. No. 61/109,355, filed Oct. 29, 2008, the contents ofeach of which are incorporated herein by reference in their entirety.

FIELD OF THE INVENTION

The present invention is directed to molds for forming orthopedicimplants and, more particularly, to molds for forming temporary spacerorthopedic implants.

BACKGROUND OF THE INVENTION

From time to time, orthopedic implants such as a knee replacement andthe tissue around the implant can become infected. The infected implantis removed, and it conventionally takes four to eight weeks or more toadequately treat the infection during which time the implant site iskept immobile. This may cause unused muscles to contract and shrink thespace previously occupied by the joint implant that connectedarticulating bones such as the space between the end of a femur and thetibia bone in the case of a knee replacement.

To prevent the shrinkage of the implant site, one treatment is toreplace the infected permanent implant with a temporary implant orspacer made of an antibiotic-filled cement to fill the void. The spacerpreserves the distance between the adjoining bones so that muscle cannotoverly contract while the infection is being cleared from the implantsite. Additionally, once positioned within the body, the antibioticleaches out of the spacer to treat tissue near the spacer and preventfurther spreading of the infection. The spacer is usually left in thevoid for four to eight weeks, but can be implanted for up to six monthsto clear the infection. Once the infection is cleared, the spacer isreplaced with a new permanent implant. Ideally this type of spacer willallow some movement and preserve joint spacing, but is not usuallyintended to support the loads encountered by healthy bone or permanent,long term implants.

Some known spacers are pre-made and are provided to the physiciansperforming the surgery. This usually provides little or no opportunityfor the physicians to significantly customize or modify the spacer tomatch the size of a patient's implant site. The pre-made spacers alsocannot be easily and quickly modified to change the implantconfiguration. For instance, the physician may at first desire a kneeimplant to have a medullar stem to be placed axially into a medullarycavity in the femur or tibia but then reverse that decision upon openingthe implant site. At that point, however, it may not be convenient, oreven possible, to remove such a stem from a pre-made knee implant.

Other spacers are molded by the physicians by filling molds with curablecement during the surgical procedure. In these cases, when hard moldsare used, substantial customization is not possible when a mold isprovided in one size and configuration. Also, relatively cumbersome,time consuming, and messy procedures are used to fill the molds. Forinstance, such hard molds are usually filled by pouring the antibioticfilled cement into mold pieces and then placing the cement into allspaces in the mold by using a spoon or spatula. In other cases, themolds are inserted in-situ at the surgical site and the implant is madewhile the mold is in-situ.

Other known relatively soft silicone spacer molds are enclosed forinjecting cement into the mold from a cement gun with a nozzle. To fillall of the spaces in the enclosed mold, extra time and effort by thephysician is required to shift and/or rotate the nozzle of the cementgun in different directions within the mold. Thus, a spacer mold isdesired that permits physicians to easily and quickly select and adjustthe size and configuration of the spacer mold, even while the implantsite is accessible, and efficiently and cleanly fill the spacer mold.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a back and right side perspective view of one form of anassembled femoral mold assembly according to the present invention;

FIG. 2 is an exploded perspective view of the mold assembly of FIG. 1;

FIG. 3 is a right side cross-sectional view of the assembled moldassembly of FIG. 1;

FIG. 4 is a front elevational view of a femoral implant formed with themold assembly of FIG. 1;

FIG. 5. a cross-sectional view of a locking member taken along line V-Von FIG. 2;

FIG. 6 is a bottom perspective view of a portion of the mold assembly ofFIG. 1 showing a member in position to cover and uncover a stem-formingcavity on a mold member;

FIG. 7 is a front perspective view of one form of an assembled tibialmold assembly according to the present invention;

FIG. 8 is an exploded perspective view of the mold assembly of FIG. 7;

FIG. 9 is a top view of an upper mold piece of the mold assembly of FIG.7;

FIG. 10 is a top view of a lower mold piece of the mold assembly of FIG.7;

FIG. 11 is a left side, cross-sectional view of the assembled moldassembly of FIG. 7 cut through a stem portion of the mold;

FIG. 12 is a left side cross-sectional view of the assembled moldassembly of FIG. 7 cut through a cement gun port formed on the moldassembly;

FIG. 13 is a front perspective view of the tibial implant formed by themold assembly of FIG. 7; and

FIG. 14 is a right side cross-sectional view of the tibial implant ofFIG. 12.

DETAILED DESCRIPTION

Referring to FIGS. 1-3, a mold assembly 10 for forming a temporaryprosthesis 100 (shown in FIG. 4) has at least two mold members 12 and 14that define a generally enclosed interior cavity 16 for forming thetemporary prosthesis 100. Mold members 12 and 14 may be provided in anumber of different alternative sizes to form implants to match the sizeof a patient's anatomy, such as a knee joint. In one form, the moldassembly 10 is provided in at least four different alternative sizeswhen the implant 100 is a femoral knee implant, such as 66×57.5 mm,70×61.5 mm, 74.5×65 mm, and 79×70.5 mm, where the first value relates tothe size in the medial/lateral direction and the second value relates tothe size in the anterior/posterior direction. The pieces of the moldassembly 10 for forming the different sizes may be provided together ina kit so that the physician can select the proper size mold pieces whilethe implant site is open. To provide even greater flexibility, the moldassembly 10 is configured to provide the option of a stemmed implant ora non-stemmed implant which can be decided during the surgical procedureas explained below.

Additionally, the mold members 12 and 14 can also form femoral kneeimplants that are configured to be placed on a specific leg, i.e., aleft leg implant or a right leg implant, for each mold size to provideeven greater adaptability for the physician while providing a temporaryimplant that better fits either the natural or abnormal curvature of theknee joint.

Furthermore, an initially separate securement structure 18 can bedetachably mounted on the mold members 12 and 14 for securing the moldmembers 12 and 14 to each other while the interior cavity 16 (FIG. 3) isbeing filled with a pressurized, curable material to form the temporaryprosthesis 100 in the cavity 16. The securement structure 18 can beeasily and quickly mounted on, and removed from, the mold members 12 and14 without the use of a tool providing the physician with a veryconvenient, quick, and clean system for forming temporary spacerimplants while the implant site is open.

In more detail, the two mold members 12 and 14 respectively form anupper mold member and a lower mold member that mate together and aresecured to each other by the securement structure 18. One of the moldmembers 12 or 14 also has two holes 13 that receive protrusions 15 (FIG.2) from the other of the two members 12 or 14 to index the two membersto each other and to limit horizontal motion relative to each other.While the two mold members 12 and 14 are the only pieces in theillustrated example that receive curing material to form the implant, itwill be understood that the mold assembly 10 may contain more than twopieces to define cavity 16.

For the illustrated example, as shown on FIG. 3, the two mold members 12and 14 respectively have interior and opposite surfaces 20 and 22 thatdefine cavity 16. The surfaces 20 and 22 are shaped to form a femoralknee implant 100 as shown on FIG. 4 with an articulating, rounded mainportion 102 to be mounted on a tibial implant, a lateral condyle 104 anda medial condyle 106 that both generally extend anteriorly from the mainbody 102, a posterior flange 108, and an optional stem portion 110extending superiorly from the main portion 102 for insertion into amedullary canal on the patient's femur to anchor the implant 100 on thebone. The distal end portions of the implant's condyles 104 and 106 andthe posterior flange 108 generally extend in a superior-inferior. Theinterior surfaces 20 and 22 respectively form a superior, bone-engagingsurface 118 of the implant 100 and an inferior articulating surface 120for engaging a tibial implant.

In order to remove the temporary implant 100 from the cavity 16 after itis formed or cured, the two mold members 12 and 14 are at leastpartially separable from one another. Thus, while the illustrated moldmembers 12 and 14 are depicted as completely separate pieces, it will beunderstood that the two pieces may be integrally formed. In that case,the two mold members 12 and 14 may be attached to each other by a livinghinge or other similar integral and flexible structure, or the two moldmembers 12 and 14 may only have certain portions that can be bent backor torn away to expose implant 100 in cavity 16 for its removaltherefrom.

In one form, the securement structure 18 includes at least two framemembers 24 and 26 disposed on different sides of the two mold members 12and 14, and at least one locking member (although six locking members28A-28F are shown here) interconnecting the two frame members 24 and 26.In the illustrated form, the two frame members 24 and 26 are disposed onopposite sides 30 and 32 (such as the left and right sides) of the moldmembers 12 and 14 so that the locking members 28A-28F extend generallyparallel in a left-to-right direction across the mold members 12 and 14.It will be appreciated, however, that while the frame members 24 and 26are placed on the left and right sides 30 and 32 (or lateral and medialsides relative the shape of the implant the molds 12 and 14 will form),the frame members 24 and 26 could be placed on the anterior/posterior orsuperior/inferior sides of the implant instead. Otherwise, the framemembers 24 and 26 may be placed on any sides of the mold members thatare spaced from each other.

In the illustrated form, the locking members 28A-28F restrict furtherseparation of the frame members 24 and 26 from each other. Sointerconnected, the frame members 24 and 26 restrict separation of thetwo mold members 12 and 14 from each other in a left-right, or ‘x’direction as shown on FIG. 1 and indicated by the Cartesian scale. Theframe members 24 and 26 restrict such motion by the mold members 12 and14 because the mold members are disposed between the frame members 24and 26.

The frame members 24 and 26 have a generally identical construction inthe illustrated form with a generally flat main wall 34 and an outer rim36 that extends laterally from the main wall 34; the main wall 34 andouter rim 36 generally defining an interior 38 of the frame members 24and 26. A number of crossing flanges 40 extend in the interior 38 fromthe main wall 34 with the same thickness as the outer rim 36. When themold assembly 10 is assembled, the frame members 24 and 26 both face thesame direction so that one side 30 or 32 of the mold members 12 and 14faces, and is pressed against, the main wall 34 on one of the framemembers 24 or 26, while the other side 30 or 32 of the mold members 12and 14 faces, and is pressed against, the flanges 40 on the other framemember 24 or 26.

The non-threaded locking members 28A-28F have elongate members 42, suchas a pin, bar, or rod or other member that extends across the moldmembers 12 and 14. The left frame member 24 has at least onethrough-hole, but here six through-holes 44A-44F to match the number oflocking members 28A-28F. Likewise, the right frame member 26 hasthrough-holes 46A-46F that align with, or more specifically aregenerally coaxial with, the through-holes 44A-44F to form pairs ofaligned holes to receive one of the locking members 28A-28F. Forexample, through-holes 44A and 46A respectively on frame members 24 and26 are generally coaxial to receive the locking member 28A. For both ofthe frame members 24 and 26, the through-holes are defined by the mainwall 34 and collars 48 extending interiorly from the main wall 34.

With the locking members 28A-28F assembled to the frame members 24 and26, at least two of the locking members extend generally parallel toeach other on different sides (here upper and lower sides) of the twomold members 12 and 14. In the illustrated form, three of the lockingmembers 28A-28C extend below lower mold member 14 while the other threelocking members 28D-28F extend above the upper mold member 12. With thisconfiguration where the mold members 12 and 14 are disposed between thelocking members 28A-28F, the locking members further restrict separationof the mold members 12 and 14 away from each other in an up-down or ‘y’direction as shown in FIG. 1.

To restrict movement of the mold members 12 and 14 in the front-back or‘z’ direction, the two mold members 12 and 14 have an array ofexteriorly extending flanges 50 each with an outer edge 52 defining arecess 54. The recesses 54 are aligned to receive the locking members28A-28F in order to mount the locking members 28A-28F on the moldassemblies 12 and 14. In one form, the recesses 54 are semicircular toflushly receive a cylindrical surface 56, for example, of each of thelocking members 28A-28F.

Whether or not the recesses 54 are semi-circular, the outer edges 52 mayhave forward and rear portions 57 and 58 that define the recesses 54 tobe sufficiently deep so that the forward and rear portions 57 and 58extend along a sufficient height of front and back sides of the lockingmembers 28A-28F respectively to retain the locking members 28A-28Fbetween the forward and rear portions 56 and 58. This in turn restrictsmovement of the mold assemblies 12 and 14 relative to the lockingmembers 28A-28F in the ‘z’ direction. Thus, in the illustrated form, thelocking members 28A-28F limit the motion of the mold members 12 and 14in at least two directions perpendicular to one another, such as in thez and y directions while the locking members 12 and 14 interconnect theframe members 24 and 26 to restrict motion of the mold members 12 and 14in the ‘x’ direction. Note, however, that other forms are contemplatedwhere such structure is not necessarily perpendicular (e.g., the lockingmembers extend at a non-normal angle from the frame members) or thepieces of the securement structure 18 mentioned above are on differentsides of the mold members than that mentioned.

Other configurations for the exterior of the mold members 12 and 14 tohold the locking members are also contemplated. For instance, instead ofmultiple flanges 50, one or more elongate or continuous grooves may beprovided on the exterior of the mold members 12 and 14 for receiving thelocking members 28A-28F. Also, instead of open recesses 54, the moldassemblies 12 and 14 may define laterally extending bores for thelocking members to extend through.

The locking members 28A-28F are disposed on the mold members 12 and 14so that moving the locking members 28A-28F axially through thethrough-holes 44A-44F and 46A-46F on the frame members 24 and 26 and inthe recesses 54 on the mold assemblies 12 and 14 can secure and unsecurethe two frame members 24 and 26 to each other, and in turn the moldmembers 12 and 14 to and from one another. To facilitate this securingand unsecuring action, at least one of the locking members 28A-28F, andin the illustrated form, all of the locking members 28A-28F, has ahand-operated, quick release mechanism instead of a threaded connectionthat may require a screw driver or may be time consuming to rotate untilreleased. Such threading may also be difficult to release if cementbecomes lodged in the threads.

For this purpose, the locking members 28A-28F each has an axially fixedfinger pull ring 60 mounted at one end 62 of the locking members 28A-28Fboth to provide assistance in removal of the locking members 28A-28Ffrom the frames 24 and 26, and to act as a retainer to restrict furtherinsertion of the locking pins 28A-28F through the through-holes 44A-44Fand 46A-46F. For this purpose, the outer diameter of the pull rings 60must be greater than the inner diameter of at least the through-holes46A-46F on the frame member 26 that directly faces the pull rings 60.The pull rings 60 may be any material that has sufficient strength towithstand being gripped and pulled by a user and being impacted by theframe member 26 caused by pressurized material filling the mold pieces.In the present form, the rings 60 are metal but may be made of plastic.

Referring to FIG. 5, the locking members 28A-28F each have a retractableretainer 64, such as a ball detent, on an end portion 66 spaced from theend 62 of the locking members 28A-28F. While the pull rings 60 aredisposed at the exterior of one of the frame members 24 or 26, theretractable retainer 64 is disposed at the exterior of the other framemember 24 or 26. In the present form, the ball detent 64 includes anaxially extending bore 68 with an opening 70 that is smaller than anouter diameter of a ball 72 disposed within the bore 68. The ball isbiased to extend out of the bore 68 and through the opening 70 by aspring 74 also disposed within the bore. Other similar configurationsmay also be used as long as a retractable protrusion extends radiallyfrom the side of the locking member 28 to retain the frame member 24when the frame member is forced outward due to forces from pressurizedmaterial filling the cavity 16, and the protrusion retracts upon asignificant axial force on the locking member to intentionally disengagethe locking member from the frame member.

With the configuration described, the fixed and retractable retainers 60and 64 axially and removably fix the locking members 28A-28F to theframe members 24 and 26 while the mold is being filled with pressurizedcement, and until a user pulls on the pull rings 60 to remove thelocking members 28A-28F from the frame members 24 and 26 after theimplant has cured. This combined structure of the frame members 24 and26 and locking members 28A-28F provides sufficient strength to hold themold members 12 and 14 together while receiving high pressures exhibitedduring injection of a curable material into the mold 10.

Referring to FIG. 3, to receive the pressurized, curable material, themold members 12 and 14 cooperatively form an internally-threaded port 76that receives a threaded nozzle of a cement injection gun, such asZimmer's Power-Flo® Bone Cement Injector. While the injected, curablematerial is setting in the cavity 16, a plug 78 or other type of insertcan be provided to close the port 76 after the curable material has beeninjected. Once the cavity 16 is filled, the plug 78 limits substantialamounts of curable material from leaking out of the mold assembly 10through the port 76 so that the mold assembly 10 may be set down in anyconvenient orientation without adversely affecting the shape of thecured implant.

Referring to FIG. 6, in another aspect of the mold assembly 10, the moldassembly 10 can be adjustable to form the temporary prosthesis 100either with or without the stem portion 110. To provide this option, themold member 12 has a stem forming section 80 that defines a stem cavity82 that is a part of the interior cavity 16. The interior surface 20 ofthe mold member 12 and that defines cavity 16 also defines an entrance84 that opens to the stem cavity 82. A movable member, or slider, 86 isdisposed in the interior cavity 16 and between the mold members 12 and14. The slider 86 can be translated to cover and uncover the entrance84. Sufficient clearance is provided between the mold members 12 and 14at the end 32 of the mold members so that one end 85 of the slider 86can extend out of the mold members 12 and 14 to be grasped and moved asshown in FIG. 1. The frame member 26 also has an opening 87 to provideclearance to provide access to the slider 86. The slider 86 has anelongate slot 88 generally extending in the direction it is to slideindicated by arrow ‘A’. A tab or protrusion 90, also generally extendingin the direction of sliding, extends on one of the mold members 12 or 14and is disposed in the slot 88 to maintain the slider 86 on a straightalignment over the entrance 84. The other of the mold members 12 or 14has a groove 92 (FIG. 1) to provide clearance for the tab 90 when themold members 12 and 14 are assembled together. So configured, the slider86 may be pushed into the mold members 12 and 14 and interior cavity 16in the direction of arrow A as shown in FIG. 6 to the position shown indashed line to close the entrance 84 to the stem cavity 82, which blockscement from entering the stem cavity 82. Alternatively, the slider 86can be pulled away from the interior cavity 16 to uncover the entrance84 (as shown in FIG. 6) and allow for filling of the stem cavity 82 tocreate a stem extension 110 (FIG. 4).

Referring again to FIG. 4, the interior surfaces 20 and 22 definingcavity 16 may be shaped to form the temporary prosthesis 100 to have abody 116 in either of a first shape specifically configured forplacement on a left leg, as shown on FIG. 4, or a second shapespecifically configured for placement on a right leg. Thus, the stemportion 110 may be formed with a valgus angle, such as a six degreevalgus angle, so that a central axis B of the stem portion 110 isgenerally inclined toward a medial side 112 of the implant 100.Furthermore, the implant 100 may be shaped so that a distal, superiortip 114 of the posterior flange 108 is disposed on the medial side 112of the implant 100.

With the description as set forth above, it will be understood that moldassembly 10 is convenient to use and provides a physician with manyoptions during the surgical procedure. The mold assemblies may beprovided to the physician in a fully assembled state or may be assembledby the physician especially when the physician is choosing which sizemold pieces to use, which may occur while the implant site isaccessible. The entire mold assembly 10 may be provided in differentsizes or alternatively a securement structure 18 may be adaptable toreceive mold members 12 and 14 of different sizes. As anotheralternative, the mold members 12 and 14 may have the same exterior sizefor attachment to a single securement structure 18 and only the interiorsurfaces 20 and 22 of alternative mold members 12 and 14 change tocorrespond to different implant sizes.

Likewise, the physician may determine whether or not a stem should beplaced in the implant 100 while the implant site is opened. Accordingly,the slider 86 may be positioned on the mold member 12 and moved toeither cover or uncover the entrance 84 to the stem cavity 82.

After positioning the slider 86, the mold members 12 and 14 areassembled together and held together by hand for instance. The lockingmembers 28A-28F may be inserted through one frame member 26 closest tothe pull rings 60 before sliding the mold members 12 and 14 between thelocking members 28A-28F. The other frame member 24 may then be securedto the locking members 28A-28F and against the side of the mold members12 and 14. Once the mold assembly 10 is securely fastened together bythe securement structure 18, the curable material can be injected intothe interior cavity under pressure by attaching a cement cartridge orgun to port 76. After the mold assembly is filled with the curablematerial, the cement gun is removed, plug 78 is placed in port 76, andmold assembly 10 then may be set down in any convenient orientation toallow the material in cavity 16 to cure inside of the mold assembly.When the temporary prosthesis has hardened, the mold assembly 10 can bedisassembled by detaching the frame member 24 from the locking members28A-28F and then sliding the locking members 28A-28F off of the moldmembers 12 and 14. In one alternative, the upper three locking members28A-28C are removed first, and the mold members 12 and 14 are thenremoved from the securement structure 18. Many other alternatives exist.The mold members 12 and 14 can then be pulled or peeled off of thehardened prosthesis or implant 100. The implant 100 is then trimmed andready for implantation while the mold assembly 10 may be discarded.

Referring now to FIGS. 7-13, a tibial mold assembly 200 has at least twomold members 202 and 204 that define a generally enclosed interiorcavity 206 therebetween for forming a temporary, tibial spacer orprosthesis 400. As with the femoral mold assembly 10, the mold assembly200 can be provided in a number of different alternative sizes to fitproperly on patient's anatomy having different sizes. In one form, themold 200 is provided in at least three different sizes including 66×42mm, 74×46 mm, and 82×51 mm, where the first value relates to the size inthe medial/lateral direction and the second value relates to the size inthe anterior/posterior direction. Also, a stem forming portion 230 ofthe mold member 202 may be plugged to provide a non-stemmed implant aswith the femoral implant, and an initially separate securement structure208 removably secures the mold members 202 and 204 to each other withsufficient strength to withstand forces impacted from filling the moldassembly 200 with pressurized, curable material while also providing aneasy, quick, and clean way to remove the mold assembly 200 from theimplant 400 by hand, and without the use of a tool. The mold assembly200, however, also has a mechanism for adjusting the thickness of thecavity 206, and in tum the implant 400 formed therein as explained ingreater detail below.

As shown on FIG. 8, the mold members 202 and 204 are generallytub-shaped, and the first or upper mold member 202 is slightly smallerto fit within the second, base, or lower mold member 204. For the tibialmold assembly 200, upper and lower refers to the orientation of the moldassembly rather than the shape of the implant since the lower moldmember 204 has a generally flat bottom rim that acts as a base for themold assembly 200. Upper mold member 202 includes a bottom wall 210, anda side wall 212 extending upwardly from the bottom wall 210. Likewise,the lower mold member 204 includes a bottom wall 214 and a sidewall 216extending upward from the bottom wall 214. The bottom wall 210 of theupper mold member 202 fits within the side wall 216 of the lower moldmember 204 so that the cavity 206 is formed between the bottom walls 210and 214. The bottom wall 210 of the upper member 202 is shaped to formthe bone-engaging, inferiorly facing surface 406 of the implant 400while the bottom wall 214 is shaped to form the superiorly facing,articulating surface 408 configured to engage a femoral implant.

Additionally, the bottom wall 210 of the upper mold member 202 mayinclude an outwardly extending lip 218, as shown on FIG. 11, to form atight seal with the side wall 216 of the lower mold member 204. The lip218 limits the amount of curable material that will flow out of cavity206 and between the sidewalls 212 and 216. The upper mold member 202also has a stem forming section 230 extending exteriorly from the bottomwall 210 and is described in greater detail below. A port 220 isprovided to inject curable material into cavity 206 and may receive aseparate, long break-away nozzle 222, as shown on FIG. 12, that extendsinto an interior of the upper mold member 202 and attaches an injectiongun or cartridge to port 220.

Referring to FIGS. 7-8, to secure the mold members 202 and 204 to eachother, the lower mold member 204 has at least one, but here two,retainers in the exemplary form of arms 224 and 226 extending inopposite directions from the side wall 216. The arms 224 and 226 have avertically accessible slot or through-opening 228 and 232 respectively.The upper mold member 202 has extensions 234 and 236 that arerespectively positioned to correspond and engage the arms 224 and 226.The extensions 234 and 236 are wing or tab shaped to be inserted throughthe through-openings 228 and 232. Each extension 234 and 236 also has atleast one hole 238 for receiving the securement structure 218 once theextensions 234 and 236 extend through the through-holes 228 and 232.

More specifically, the through-openings 228 and 232 each have aninsertion side 240 and an exit side 242 through which it receives a partof the extensions 234 and 236 therethrough. The hole or holes 238 aredisposed on the extensions 234 and 236 so that once the extensions 234and 236 extend through the arms 224 and 226, the holes 238 are disposedexteriorly of the exit side 242 of the through-openings 228 and 232. Inthe illustrated form, once the extensions 234 and 236 extend through thearms 224 and 226 as described, the securement structure 218, which is atleast one pin 244, is placed in the holes 238 to secure the upper moldmember 202 to the lower mold member 204. With this configuration, as thecavity 206 is filled with curable material, the upper upper mold member202 will move away from the lower mold member 204. This motion will liftthe extensions 234 and 236 farther out of the through-openings 228 and232 until the pins 244 engage the retaining arms 224 and 226 of thelower mold 204. Thus, the retainers or arms 224 and 226 limit furthermotion of the pins 244 which in turn limits motion of the extensions 234and 236 and prevents the upper mold member 202 from lifting out of thelower mold member 204, thereby securing the mold members 202 and 204together.

To limit unintentional disengagement of the pins 244 from the holes 238,the pins may have pull rings 246 on one end portion 248 and retractableball detents 250 on the other end portion 252 of the pins 244 as withthe pins or locking members 28 on the mold assembly 10. When fullyassembled, the pull rings 246 and detents 250 are disposed on oppositeside of the extensions 234 and 236. The pull ring 246 also assists withremoval of the pin 244 from the extension. It will be appreciated,however, that other configurations for the pin 244 are possible as longas a convenient and quick disengagement between a pin and the extensionis provided.

This configuration permits the mold assembly 200 to be adjustable sothat implants 400 with different superior-inferior thicknesses orheights may be provided by adjusting the height in the cavity 206between the bottom wall 210 on the upper mold member 202 and the bottomwall 214 on the lower mold member 204. Specifically, each extension 234and 236 has a plurality of holes 238 where each hole on an extension 234and 236 has a different vertical position relative to the bottom wall214 of the lower mold member, and therefore corresponds to a differentheight within the cavity 206. Since the engagement of the pins 244 withthe extensions 234 and 236 forms the maximum height at which the uppermold member 202 will lift away from the lower mold member 204, themaximum height between the bottom walls 210 and 214 can be selected byinserting the pins 244 in holes 238 on extensions 234 and 236 thatcorrespond to the desired implant height. Indicia 254 may be providednear each hole 238 on each extension 234 and 236 to indicate the implantheight that will be attained by placing the pins 244 in those holes 238.In the illustrated form, five holes 238 are provided on each extensionto provide implant 400 with alternative superior-inferior thicknesses of10 mm, 12 mm, 14 mm, 17 mm, and 20 mm.

Referring to FIG. 11, the temporary tibial prosthesis 400 may have anoptional stem portion 402 (shown on FIGS. 13-14) formed by stem formingsection 230 on the upper mold member 202. The stem forming section 230defines a stem cavity 256 that has an entrance or aperture 258 forreceiving curable material. When a stem is not desired, a plug 258 canbe inserted through entrance 258 and into stem cavity 256 to close thestem cavity.

Another optional aspect of the mold assembly 200 is that either thelower mold member 204 can form the entire articulating surface 408 ofimplant 400 out of the curable material or a bearing member insert 260may form the articulating surface 408 of the tibial implant 400. In thatcase, the insert 260 is placed in the mold member 204 prior to additionof the curable material to become embedded on the implant 200. Theinsert 260 can be provided when a surgeon feels that a cement on cementarticulation is not desirable which occurs when the articulatingsurfaces of both the femoral prosthesis and the tibial prosthesis aresubstantially made out of bone cement.

More specifically, a main portion 404 of the implant 400 is generallyflat to form the tibial plateau and is generally C-shaped in plan view(see FIG. 13) to correspond to the shape of the condyles on the femoralimplant which the main portion 404 will support. As shown in FIG. 8, theinsert 260 generally matches the C-shape in plan view to adequatelyengage and support the femoral implant. When placing the insert 260 inthe mold assembly 200, an exterior articulating surface 262 (FIG. 8) onthe insert 260 is placed against the bottom wall 214 of the lower moldmember 204. To aid in locating the insert 260 in a proper positionwithin the mold member 204, at least one aperture (although twoapertures are shown) 264 is formed on the articulating surface 262 andthat corresponds to, and receives, protrusions 266 (shown in FIGS. 10and 12) extending interiorly from bottom wall 214 of the mold member204.

Referring to FIGS. 11 and 14, in order to anchor the insert 260 in thecurable material, the insert 260 has a rim 268 that extends rearwardlyor interiorly from a main portion 270 forming the articulating surface262. The rim 268 has a hooked or lipped distal end portion 272 to beentirely embedded within the curable material to anchor the inserttherein. So configured, once the curable material, or bone cement, ispoured into the mold assembly 200, the curable material surrounds therim 268 and distal end portion 272, and the insert 260 becomes lockedinto place after the bone cement cures within the mold 200.

If such cement on cement articulation is desirable, then the insert 260would not be provided or inserted into the mold 200. In this case, thecement used in the mold member 204 may include features to form a smoothtexture on the articulating surface 408 such as a fine (non-textured)finish on the mold interior surface.

For the bone engaging surface 406 of implant 400, the bottom wall 210 ofthe upper mold member 202 can be shaped to form a macro texture, such aslarge blind holes, in the bottom surface of the cured temporaryprosthesis 400. These macro textures can increase the strength of theconnection between the implant 400 and bone cement used as adhesive tofix the implant 400 to the tibia.

Typically the mold members 12, 14, 202 and 204 can be injection moldedpieces, preferably made out of a plastic material such as a high densitypolyethylene or any other type of plastic that does not stick to thecurable material used to form the prosthesis. Other types of moldmaterials may comprise hard polymers or a solid core of steel withcobalt-chromium on the exterior of the core. In one aspect, the moldassemblies 10 and 200 provide a sterile yet single-use mold assemblythat is disposable after formation of the initial prosthesis. At leastone or more of the mold members 12, 14, 202 and 204 can also contain atear strip feature, such as tear strip 274 shown on FIG. 7, shaped intothe mold member for assistance in disassembling of the mold after theprosthesis has cured. The tear strips can further be configured torender the molds unusable after the tear strips have been used to removethe prosthesis from the mold, thus ensuring the single-use status of themold assembly and limiting contamination.

The mold members 12, 14, 202 and 204 in both embodiments discussed abovemay also contain optional vents in one or all of the mold members. Thevents can allow air to escape during the injection of the curablematerial and can further provide a visual indicator that the mold isfull, such as when the curable material begins to extrude out of thevents. The curable material that is used for the curing and forming ofthe temporary prosthesis can comprise a bone cement material that istypically known in the art, such as a material made out of polymethylmethacrylate (PMMA), or other similar materials. Optionally, anantimicrobial component can be added to the mixture of the curablematerial to provide a temporary prosthesis that has antimicrobialproperties therein. Any known antimicrobial component may be utilized,and in particular, antibiotics such as gentamycin or clindamycin can beused.

In the tibial example disclosed in FIGS. 7-14, the bearing member orinsert 260 can also be a plastic injection molded material, such aspolyethylene or polyetheretherketone (PEEK), however, other materialsmay be used such as a metal insert or any other bearing surface that isdesired.

As with mold assembly 10, it will be understood that mold assembly 200also conveniently provides a physician with many options during thesurgical procedure. The mold assembly 200 may be provided to thephysician in a fully assembled state or may be assembled by thephysician especially when the physician is choosing which size moldpieces to use and whether or not to use a stem 402 and/or a bearinginsert 260 while the implant site is accessible. Accordingly, thephysician may place the insert 260 in mold member 204 (or remove ittherefrom) and position plug 257 in stem cavity 256 if the stem is to beomitted, all while the implant site is accessible.

To then assemble the mold assembly 200, the upper mold member 202 isplaced on the lower mold member 204 so that the extensions 234 and 236are respectively placed through arms 224 and 226. So positioned, andwhile the implant site is accessible as desired, the pins 244 are placedthrough the extensions 234 and 236 at selected holes 238 that correspondto a desired thickness or height of the implant 400 to be formed.

Once the mold assembly 200 is securely fastened together by thesecurement structure 208, a cement cartridge or gun is attached to thebreak-away nozzle 222 mounted on the port 220 to inject the curablepressurized material into the interior cavity 206. The mold assembly 200may be set down once it is filled with the curable material. After theimplant 400 is cured, the mold assembly 200 can be disassembled bydetaching the pins 244, and removing the upper mold member 202 from thelower mold member 204. Tear strips 274 as mentioned above may beprovided along the sides of the mold members 202 and/or 204 to assistwith peeling the mold members 202 and 204 off of the implant 400.

It should be noted that all or parts of the securement structuredescribed above could be integrally formed with the mold members. Forinstance, the frame members 24 and 26 on mold assembly 10 may each beintegrally formed with one of the mold members 12 or 14. Likewise, moldmember 204 of mold assembly 200 may have an integral pin for engagingone of multiple holes on the mold member 202.

In the presently illustrated forms, however, the non-threaded securementstructures are at least partially and initially separate from the moldmembers in order to secure the mold members together in multipledirections (e.g., x, y, and z directions) while withstanding therelatively high forces from the pressurized curing material, and whilestill allowing easy disassembly of the mold members from each other. Forthe structures described for mold assembly 10 then, and as mentionedabove, it is possible to assemble or disassemble the securementstructure piece by piece. Thus, connecting the securement structure tothe mold members may include mounting the mold members on a partiallyassembled frame, and completing the assembly of the frame to secure thetwo mold members together. Similarly, after the temporary prosthesis 100or 400 is set, it is possible to detach at least a part of thesecurement structure from the mold members before disassembling the moldmembers from each other to retrieve the temporary prosthesis. Whetherconnecting the securement structure to the mold members or detaching atleast a part of the securement structure from the mold members, this mayinclude axially moving, by hand, at least one pin interconnecting atleast two frame members disposed on different sides of the mold members.

While this invention may have been described as having a preferreddesign, the present invention can be further modified within the spiritand scope of this disclosure. This application is therefore intended tocover any variations, uses, or adaptations of the invention using itsgeneral principles. Further, this application is intended to cover suchdepartures from the present disclosure as come within known or customarypractice in the art to which this invention pertains and which fallwithin the limits of the appended claims.

1-20. (canceled)
 21. A method of forming a prosthesis, comprising:assembling at least two mold members to cooperatively define a generallyenclosed interior cavity; detachably connecting a non-threadedsecurement structure to the assembled at least two mold members, thenon-threaded securement structure configured secure the at least twomold members to each other without use of a tool; depositing a curablematerial within the interior cavity; and curing the curable material.22. The method of claim 21, wherein detachably connecting thenon-threaded securement structure includes interconnecting a first framemember, coupled to one of the at least two mold members, and a secondframe member, coupled to another one of the at least two mold members.23. The method of claim 21, wherein detachably connecting thenon-threaded securement structure includes mounting the at least twomold members on a partially assembled frame and completing assembly ofthe frame to secure the at least two mold members to each other.
 24. Themethod of claim 21, wherein detachably connecting a non-threadedsecurement structure includes moving a non-threaded pin in a directionto secure the at least two mold members to each other.
 25. The method ofclaim 21, wherein detachably connecting a non-threaded securementstructure includes positioning a first frame member and a second framemember on opposing sides of the assembled at least two mold members, andaxially moving at least one pin to interconnect the first frame memberand the second frame member.
 26. The method of claim 21, whereindetachably connecting a non-threaded securement structure includesaxially moving at least one pin to interconnect a first frame member,disposed on one of the at least two mold members, and a second framemember, disposed on another one of the at least two mold members. 27.The method of claim 21, further comprising detaching at least a part ofthe non-threaded securement structure from one of the at least two moldmembers to release the securement of the at least two mold members. 28.The method of claim 27, wherein detaching at least a part of thenon-threaded securement structure includes moving a non-threaded pin ina direction to release the securement of the at least two mold members.29. The method of claim 27, wherein detaching at least a part of thenon-threaded securement structure includes axially moving at least onepin interconnecting a first frame member and a second frame member, thefirst frame member and the second frame member disposed on differentsides of the assembled at least two mold members.
 30. The method ofclaim 27, wherein detaching at least a part of the non-threadedsecurement structure includes axially moving at least one pininterconnecting a first frame member, coupled to one of the at least twomold members, and a second frame member, coupled to another one of theat least two mold members.
 31. The method of claim 21, whereinassembling at least two mold members includes securing a first moldmember relative to a second mold member at one of a plurality ofpositions, each one of the plurality of positions providing a differentdimension within the interior cavity.
 32. The method of claim 21,wherein assembling at least two mold members includes placing at leastone extension of a first mold member through an opening defined on asecond mold member.
 33. The method of claim 32, wherein detachablyconnecting the non-threaded securement structure includes inserting apin into a hole defined on the extension to secure the extension to thesecond mold member.
 34. The method of claim 33, wherein inserting thepin further includes inserting the pin in one of a plurality of holesdefined on the extension, each one of the plurality of holescorresponding to a different secured position of the first mold memberrelative to the second mold member.
 35. The method of claim 33, whereininserting the pin further includes inserting the pin in one of aplurality of holes defined on the extension, wherein each one of theplurality of holes corresponds to a different dimension of the interiorcavity.
 36. The method of claim 21, further comprising, beforedepositing the curable material, inserting a bearing member into one ofthe at least two mold members or into the interior cavity.
 37. Themethod of claim 21, wherein depositing the curable material includesinjecting a pressurized curable material into the interior cavity.
 38. Amethod of forming a prosthesis, comprising: assembling a first moldmember and a second mold member to define a generally enclosed interiorcavity, including positioning the first mold member relative to thesecond mold member at a select position from among a plurality ofselectable positions; securing the first mold member to the second moldmember with a non-threaded locking member; depositing a curable materialwithin the interior cavity; and curing the curable material.
 39. Themethod of claim 38, wherein positioning the first mold member relativeto the second mold member includes selecting a dimension of interiorcavity of the mold by inserting the first mold member at least partiallywithin a cavity defined by the second mold member .
 40. The method ofclaim 39, wherein securing the first mold member to the second moldmember includes inserting the non-threaded locking member through a holedefined by the first mold member or the second mold member, the holecorresponding to the select dimension of the interior cavity.